Impact of an in-person small group surgical skills course for preclinical medical students in an era of increased e-learning.

Objective: The COVID-19 pandemic led to a dramatic decrease in face-to-face teaching. This can particularly impact medical students' skills development. This prompted development of an in-person surgical skills course as guided by the General Medical Council "Outcomes for Graduates" facilitated by tutors with surgical experience. This study aimed to primarily assess participant confidence in surgical skills following the course. Design: This was an interventional study assessing both qualitative and quantitative data collected prior to, during, and post course completion. Data were collected from students via online forms, which included a mixture of "Yes/No" responses, self-assessed confidence levels via Likert scales, and free type questions. Setting: The study assessed feedback for a 5-session surgical skills course delivered at the authors' institution. This is a newly designed course using low-cost materials which was free for all attendees. Participants: Participants were all in the first or second year of medical school. There was capacity for 60 students, and all attendees provided informed consent to participate. Results: A total of 446 students applied for the course with 58 participants in the final study, 31% of whom had prior surgical skills experience. There was a statistically significant increase in student confidence levels following the course for all taught surgical skills (P = .0001). Participants were also more confident that they possessed the skills required for clinical placements (P = .0001) and to work as a junior doctor (P = .01). Thematic qualitative analysis revealed a reliance on third parties for previous surgical experience; this course improved knowledge and skills for future practice. Limitations included session duration and equipment choice. Conclusion: This study demonstrates high demand and student satisfaction from this course, offering a potential framework to improve undergraduate surgical skills teaching. The results presented here have the potential to inform wider curricula development across medical schools in the future. Competencies: Medical knowledge; practice-based learning and Improvement.

Zoster meningitis in an immunocompetent young patient post first dose of BNT162b2 mRNA COVID-19 vaccine, a case report.

Recently published observational data suggests an increased risk of herpes zoster infection post-vaccination with the BNT162b2 mRNA vaccine. We describe the case of VZV meningitis post BNT162b2 mRNA vaccination in a young immunocompetent patient. A 39-year-old patient with no medical history presented with a vesicular rash, headache, nausea and fever, days after receiving BNT162b2 mRNA vaccination. CSF analysis revealed a pleocytosis, and VZV DNA was confirmed by PCR testing. The patient received intravenous aciclovir with resolution of symptoms within 48 h. He was discharged after 14 days of treatment. Case reports of herpes zoster reactivation post vaccination and details of subsequent successful vaccination course completion have allowed us to recommend the patient receive his second dose of the BNT162b2 mRNA vaccine. At the time of writing, however, the patient has declined to receive further vaccination due to fears of an adverse event. To the best of our knowledge, this is the first reported case in a young patient of herpes zoster meningitis following COVID-19 mRNA vaccination. The sharing of clinical experiences and reporting of suspected side effects, particularly for vaccines that employ novel technology, increases knowledge of the safety profile of these vaccines and allows clinicians to better aid patients make informed decisions with regard to commencing and completing vaccination.

An integrative review of primary health care nurses' mental health knowledge gaps and learning needs.

Background: The global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues. Aim: To critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care. Design and methods: An integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis. Data sources: CINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC. Findings: Of the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers. Discussion: Despite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care. Conclusion: Findings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.

The impact of COVID-19 on complementary and alternative medicine providers: A cross-sectional survey in Norway.

BACKGROUND: The Norwegian authorities decided in March 2020 to implement a nationwide lockdown to prevent spread of the COVID-19 virus. The lockdown had vast socioeconomic consequences for the society. The aim of this study was to investigate how COVID-19 affected Complementary and Alternative Medicine (CAM) providers' practice, financial situation, recommendations to patients, and how they perceived their future practice as CAM providers. METHOD: Data were collected in this cross-sectional survey using a self-administrated electronic questionnaire. A total of 581 CAM providers completed the questionnaire, which was designed to describe consequences for CAM providers and their clinical practice caused by the nationwide lockdown. Descriptive statistics were carried out using frequency analyses to describe the demographics and consequences of the lockdown. Between group differences (gender and age) were analyzed using Pearson chi-square tests and Fisher's exact tests for categorical variables, and ANOVA tests and t-tests for continuous variables. Significance level was defined as p < 0.05 without adjustment for multiple comparisons. RESULT: During the nationwide lockdown of Norway, 38.4% of the respondents were able to provide CAM treatment to their patients. Of those, the majority (96.4%) had reorganized their clinical practice in accordance with COVID-19 hygiene regulations, offered video consultations (57.4%) or telephone consultations (46.6%). To manage financially during the lockdown, half of the providers spent their savings (48.7%). More than one third (35.1%) was supported by their partner, and 26.7% received compensation from the Norwegian state. A total of 26.3% of the CAM providers had other paid work that provided them with income. Nearly a fifth (18.6%) borrowed money from friends and family, changed their loan terms, or took out new bank loans. More than half (62.7%) expressed uncertainty about the future of their practice. CAM providers who had reorganized their practice to online consultations were more optimistic. CONCLUSION: The impact of COVID-19 on CAM providers was considerable. It adversely affected their clinical practice, financial situation, and view on their future practice. To ensure that the health needs of the Norwegian population regarding CAM use are met during pandemic times like COVID-19, it is recommended to support and train CAM providers in the development of online CAM services, as well as efficient implementation of infection prevention and control measures.

Changing to remote management of a community heart failure population during COVID-19 - Clinician and patient perspectives'.

BACKGROUND: The COVID pandemic has challenged the traditional methods used in care of patients with heart failure (HF). Remote management of HF patients has been recommended in order to maintain routine standards of care, but satisfaction with this platform of care is unknown. We set out to address the physician and patient opinion of remote management of HF during COVID-19. METHODS AND RESULTS: An observational report of the use of a Structured Telephonic assessment (STA) in stable outpatient HF patients. Physician grading of the STA was complemented by 100 randomly chosen patients to ascertain patient satisfaction and comment. 278 patients underwent a STA. Patient preference for STA was noted in 66%. Convenience was the single most cited reason for this preference (83.3%). The STA was deemed satisfactory by clinicians in 67.6%. The two-leading reasons for clinician dissatisfaction were data gaps providing a barrier to titration (55.6%) and need for clinical exam (18.9%). The annual review appointment visit subtype possessed the highest levels of satisfaction congruence amongst both clinicians and patients. CONCLUSION: In summary, this report demonstrates reasonable patient / physician satisfaction with STA, and provides some direction on how this care platform might be sustained beyond the COVID crisis.

Service delivery during the COVID-19 pandemic: Experience from The Oxford Bone Tumour and Soft Tissue Sarcoma service.

The COVID-19 (Coronavirus disease 2019) pandemic has caused an unprecedented strain on healthcare systems across the globe. Apart from being a major hurdle to delivery of basic healthcare services, this may be associated with potential harm for cancer patients. Usually being immunocompromised, cancer patients are at a higher risk of contracting the disease and with hospitals being a potential source of the infection, an urgent need to reorganise the structure of delivery of cancer care is essential. Cancer departments must balance patient care whilst also minimising transmission among patients and healthcare professionals. The Oxford Sarcoma Service was re-structured based on the guidelines issued by the National Health Service (NHS) and the British Orthopaedic Oncology Society (BOOS) to deliver unhindered care to patients. Prioritising patients who needed urgent surgery, weighing the risk-benefit ratio while delivering adjuvant treatments and conducting regular virtual multi-disciplinary team (MDT) meetings combined with personal protection equipment (PPE) usage by all involved healthcare workers were salient features in terms of ensuring the delivery of effective care during the COVID-19 pandemic. Our new model of modus operandi during this global crisis was effective in delivering high standard of care to patients and might serve as a guide to similar units managing bone and soft tissue tumours.